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Principles of Medical Laboratory Science 2 MODULE 1- 12 2ND SEMESTER I S.Y 2021 – 2022 LECTURER: DR. MA. TERESA MARCELO MODULE 1: PHLEBOTOMY AND THE HEALTH- By the 1...

Principles of Medical Laboratory Science 2 MODULE 1- 12 2ND SEMESTER I S.Y 2021 – 2022 LECTURER: DR. MA. TERESA MARCELO MODULE 1: PHLEBOTOMY AND THE HEALTH- By the 1800‘s the popularity of CARE DELIVERY SYSTEM bloodletting was high. For the procedure, the physician would make an incision in veins or arteries. They also used ‗cupping‘, a method of blistering the skin so blood could be released A Brief History of Phlebotomy from the blisters. Leeches were also used to suck up blood (apparently, they can suck up ten Phlebotomy is the act of drawing or times their body weight in blood). Bloodletting at removing blood from the circulatory system the time was used to cure acne, asthma, cancer, through a cut (incision) or puncture in order to cholera, coma, convulsions, diabetes, epilepsy obtain a sample for analysis and diagnosis. and much more. Phlebotomy is also done as part of the patient's Did bloodletting work? It may treatment for certain blood disorders. have in some cases. If a person had Phlebotomy‘s history actually began as high blood pressure, perhaps releasing ―Bloodletting,‖ which was first practiced by the some blood may have helped. If a ancient Egyptians around 1000 BC. It was person had a high iron level, blood- believed that literally letting blood out of the letting may have reduced it. Of course, body would cure diseases like acne or the there are those people who truly plague, and some believed that the practice believed it would help, so it would; would even cast out evil spirits. today, we call it that placebo effect. Bloodletting became popular and spread Of course, releasing too much to the Greeks and the Romans and then blood from a body will do irreparable through Europe in the Medieval era. The harm. Phlebotomy as we know it today thought surrounding the practice was that blood has a different use. It not used to simply was stagnant in the extremities, not flowing release blood from the body, but to through the body as we know it does today, and acquire a sample of blood from a thus would cause disease. Releasing the patient for diagnostic tests under a stagnant blood would cure the patient by physician's orders. Moreover, taking a forcing the blood to move. blood sample is a quick, safe and In the Middle Ages, bloodletting was not virtually painless procedure, performed performed by physicians, but by barber- by a certified phlebotomist, in a surgeons. These barber-surgeons also healthcare environment, using sterile performed amputations and pulled teeth. tools. Believe it or not, the red stripe on a barber pole originated from the time when barbers DUTIES OF THE PHLEBOTOMIST performed blood-letting; the red stripe was symbolic of the bloodletting portion of their Traditional Duties: profession. At some point in the 16th century, 1. Correct identification and surgery became more sophisticated and the job preparation of the patient before of bloodletting went back to the physicians. sample collection. 2. Collection of the appropriate amount of blood by venipuncture or  dermal puncture for the specified tests. HEALTH CARE SETTING 3. Selection of the appropriate sample containers for the specified tests. Health care facilities are categorized as: 4. Correct labelling of all samples with the required information. 1. In-patient (non-ambulatory) that requires 5. Appropriate transportation of patient to stay in the hospital for at least one samples back to the laboratory in a night to be serviced by tertiary care timely manner. practitioners. 6. Effective interaction with patients 2. Outpatient, in which patients are served by andhospital personnel. secondary care specialists on the same day. 7. Processing of samples for delivery to the All patients are serviced by appropriate laboratory departments. primary, secondary, and tertiary levels of 8. Performance of computer operations and healthcare. record-keeping pertaining to phlebotomy.  Primary level refers to health unit in 9. Observation of all safety regulations, the rural areas and sub-units which quality control checks, and preventive are operated by the DOH. maintenance procedures.  Secondary level refers to non- 10. Attendance at continuing education departmentalized hospitals that programs. attend to patients during symptomatic stages of an ailment. PHLEBOTOMY AND THE CHANGING  Tertiary level refers to medical HEALTH-CARE SYSTEM centers and large hospitals where services are sophisticated and In recent years, changes to increase coupled with highly technical facilities the efficiency and cost effectiveness of the that can address serious diseases. health-care delivery system have affected the duties of the phlebotomists in many institutions. These changes can range from the cross-training of persons already located in nursing units to perform basic interdisciplinary bedside procedures to the actual relocation of specialized radiology and clinical laboratory equipment and personnel to the patient-care units. This also may be referred to as patient- focused care. Considering the amount of time spent by phlebotomists travelling to and from the laboratory to patient-care units, decentralization of phlebotomy was one of the There are also other healthcare services first changes to occur. This decentralization such as ambulatory care, homebound has been accomplished by either cross- services, and public health services which training personnel working in the patient units provide services and procedures for to perform phlebotomy or transferring patients after their discharge from the phlebotomists to the patient units and cross- hospital. training them to perform basic patient-care 1. Ambulatory care is medical care given to tasks. Based on institutional protocol, outpatients or patients requiring care or phlebotomists also may be trained to perform follow-up check-ups after their discharge more advanced blood collection procedures.  from the hospital which can be in a free- standing medical care setting and hospital owned clinics or in the outpatient‘s department and urgent care facilities. 2. Homebound services refer to procedures, tests, and services, provided to a patient which are done in the patient‘s home or in a long-term facility. 3. Public health services belong to the unit at the local level but are still under the jurisdiction of the health department of the govt. services offered are with little or no charge at all. Additional Duties of Phlebotomists: 1. Training other health-care personnel to perform phlebotomy. a. Compassionate. A Phlebotomist‘s primary 2. Monitoring the quality of samples collected duty is drawing blood. Because some on the units. patients or clients are afraid of having their 3. Evaluation of protocols associated with blood drawn, it is especially important that sample collection. Phlebotomists are caring and 4. Performing and monitoring point-of-care understanding while performing their testing (POCT). duties in order to make the patient feel as 5. Performing electrocardiograms. comfortable and at ease aspossible. 6. Performing measurements of patient‘s vital b. Detail oriented. Phlebotomists must draw signs. the correct vials of blood for the tests 7. Collection of arterial blood samples. ordered,track vials of blood, and enter data 8. Collection of samples from central venous into a database. Attention to detail is a access devices (CVADs). must; otherwise, specimens may be misplaced or lost, or a patient may be Qualities of a Phlebotomist injured. It is also especially important for Phlebotomists to keep their work Phlebotomy technician is a skilled, environment clean and organized in order knowledgeable professional who works with to avoid confusion or causing infection and the public on a day-to-day basis performing other complications. venipuncture procedures. c. Hand–eye coordination. Drawing blood is Although knowledge of phlebotomy is a complicated task that phlebotomist must required in order to practice venipuncture, it is do several times a day. They are one part of the equation that helps to make a responsible for drawing blood from many good phlebotomist. patients, and they must perform their In addition to having a strong grasp duties successfully on the first attempt, or concerning phlebotomy, a good phlebotomist their patients will experience discomfort or is someone who also possess good traits. A pain. knowledgeable phlebotomist with good traits isa d. Flexible with Ability to Multitask. phlebotomist of great value. Laboratories can be a very busy place. Doctors, nurses and patients often rely  heavily on the results from blood work in procedures required for infants, young order to determine proper diagnosis and children and the elderly. In a situation where treatment for patients. Because so many a child may be disagreeable or makes it people rely on these results, Phlebotomists impossible to collect blood, an anxious must have the ability to multitask and parent would welcome a phlebotomist with oftentimes meet tight deadlines and such a characteristic. requests. h. Being Able to Calm Down Patients. The e. Team Player. Because any medical staff is ability to calm anxious patients and put essentially a big team, it‘s important for a them at ease is a desirable quality among phlebotomist to be able to work well with healthcare professionals. When working other people in order to deliver the highest with patients, it is extremely important for standardof care possible to patients. phlebotomists to calm the fears of their f. Respectful. One trait that a phlebotomy patients while allowing them to gain technician should possess is the ability to confidence in the phlebotomist as a person provide respect to all patients. As a and as a professional. When a patient professional who works with a diverse gains confidence in a phlebotomist, population on a day-to-day basis, respect blood collection procedures become is required by all phlebotomy technicians. extremely easy and pleasant for all Respect is easily shown to patients when involved. phlebotomists introduce themselves prior to i. Responsible. As phlebotomists are given the performance of any phlebotomy one of the first steps in determining the procedure. Respect is also shown when health condition of patients, it is imperative patients are greeted by their full name or to have phlebotomists who are responsible asked permission to be addressed by individuals. The diagnostic testing and the first name only. When patients are early treatment of any health condition provided step- by-step instructions during begins with the correct steps taken by a the performance of a phlebotomy phlebotomist. Such steps include correct procedure, this is also a form ofrespect. patient identification, correct venipuncture g. Patient. One of the greatest qualities that procedures and labeling of evacuated any phlebotomist could possess is a high tubes. A mistake in any phlebotomy process level of patience. As a phlebotomist who could lead to contaminated blood works with countless patients from various specimens or a patient being misdiagnosed cultural backgrounds and individuals of with a medical condition that may not exist. various age groups, patience is a necessity. The responsibility of obtaining accurate As such, this quality may be required in blood results begin with a responsible situations where a phlebotomist is unable to phlebotomist. understand a patient‘s verbal request due j. Honesty and Integrity. The phlebotomists to a language barrier. As a language barrier should never hesitate to admit a mistake, can range from a difference in dialect to the because a misidentified patient or use of a different language, patience is mislabeled sample can be critical to required in order to obtain effective patient‘s safety. Patient confidentiality must communication. In such an instance, it may be protected, and patient information is be necessary for the phlebotomy never discussed with anyone who does not technician to take time and listen have a professional need to know it. Keep carefully to information being stated or in mind that the cafeteria and elevators are request the assistance of an interpreter. used by visitors and relatives not just As patience is a virtue, it is a trait hospital employees, and hospital that is extremely useful during venipuncture employees can have family members and  neighbors as patients. caring and understanding while performing their k. Pleasing Appearance- Each organization duties in order to make the patient feel as specifies the dress code that it considers comfortable and at ease aspossible. most appropriate, but common to all 2. Steady hands. a phlebotomy technician institutions is a neat and clean appearance with steady hands is a phlebotomy technician that portrays a professional attitude to the who is valued by patients. Such a phlebotomist patient. is valued due to his or her abilityto control hand General Appearance Guidelines: movements during venipuncture procedures. 1. Clothing and laboratory coats/gowns 3. Be patient. one of the greatest qualities that must be clean and unwrinkled. any phlebotomist could possess is a high levelof 2. Shoes must be clean, closed toed. patience. As a phlebotomist who works with 3. Hair must be clean neat, trimmed or tied. countless patients from various cultural 4. Fingernails must be clean and short. backgrounds and individuals of various age groups, patience is a necessity. l. With Good Communication Skills- Good communication skills are needed for the 4. Hand–eye coordination. drawing blood is a phlebotomist to function as the liaison complicated task that phlebotomist must do between the laboratory and the patients, several times a day. They are responsible their family and visitors, and other health- care personnel. The three components of for drawing blood from many patients, and they communication-verbal skills, listening kills, must perform their duties and nonverbal skills or body language- are successfully on the first attempt, or their needed for effective communication. patients will experience discomfort or pain. 5. Calm tone of voice. when working with the public, a calm tone voice is very important. Although a phlebotomist may occasionally encounter a disgruntled patient, he or she is still expected to exhibit calmness. Regardless of a patient‘s mannerism, the professional phlebotomist should still address such patient appropriately by thoroughly answering questions and providing him or her with information necessary to complete any phlebotomy procedure. 6. Detail oriented. phlebotomists must draw the correct vials of blood for the tests ordered, track vials of blood, and enter data into adatabase. 7. Be Responsible. the diagnostic QUALITIES OF A PHLEBOTOMIST: testing and the early treatment of any health condition begins with the correct 1. Compassion.a phlebotomist‘s primary duty steps taken by a phlebotomist. Such is drawing blood. Because some patients or steps include correct patient clients are afraid of having their blood drawn, it identification, correct venipuncture is especially important that phlebotomists are procedures and labeling of evacuated tubes. A mistake in any phlebotomy affecting a specific age group or of a long-term process could leadto contaminated blood nature. specimens or a patient being misdiagnosed with a medical condition 3. District/first-level referral hospital. a that may not exist. hospital at the first referral level that is responsible for a district or a defined Communication Skills in Healthcare geographical area containing a defined population and governed by a politico-  Communication skills in a administrative organization such as a district healthcaresetting include the way you use to: health management team.  Explaining diagnosis, Following functions: investigation andtreatment.  it is an important support for other  Involving the patient in the health services and for health care in decision-making. general in the district;  communicating with relatives.  it provides wide-ranging technical and  communicating with other administrative support and education health careprofessionals. and training for primary health care;  breaking bad news.  it provides an effective, affordable  Seeking informed health-care service for a defined consent/clarification for an population, with their full participation, in invasive procedure or obtaining cooperation with agencies in the district consent for a post-mortem. that have similar concerns.  dealing with anxious patients or 4. Primary Health-care Centre. a relatives. center that provides services which are  giving instructions on discharge. usually the first point of contact with a  giving advice on lifestyle, health health professional. They include promotion or risk factors. services provided by general practitioners, dentists, community Although communication is not our goal nurses, pharmacists and midwives, in medical encounter, this will help us establish a among others. rapport and friendly environment. Our goal is to figure out what is going wrong with the 5. Birth centers. a birth center is a patient physically and psychologically in order to healthcare facility for childbirth that help them. A good communication skill is a focuses on the midwifery model. They wonderful magical means to achieve our goal, aim to create a birth environment that which is the patient‘s well-being. feels more comfortable to the mother and allows for a cost-effective, family- DIFFERENT TYPES OF HEALTHCARE inclusive birth. SETTINGS: 5. Blood banks. blood banks allow 1. General hospital. a hospital that provides a donors to donate blood and platelets range of different services for patients of while also storing and sorting blood into various age groups and with varying disease components that can be used most conditions. effectively by patients. 2. Specialized hospital. a hospital admitting 6. Clinics and Medical offices. the primarily patients suffering from a specific definition of a clinic is ―a facility for disease or affection of one system, or reserved diagnosis and treatment of outpatients.‖ for the diagnosis and treatment of conditions 7. Dialysis centers. dialysis is a 2. Clinical Analysis Area which is divided process that filters and cleans the blood into 7 areas: artificially—the work functioning kidneys  Hematology normally take on.  Serology/Immunology 8. Hospice homes. it represents a  Chemistry philosophy of care provision for dying  Microbiology patients as well as official networks that  Urinalysis offer hospice care.  Blood Bank/Immunohematology 9. Mental Health and Addiction treatment centers. mental health DIFFERENT SECTIONS IN THE LABORATORY: treatment facilities sometimes exist as a general institution for any mental health Clinical Microscopy issue and are sometimes specialized. this section performs routine and special Examples of these kinds of facilities are tests on patients‘ urine and fecal samples. These suicidal thoughts (or suicidal ideation) samples are chemically analyzed and examined treatment, depression treatment, trauma in the microscope. and post-traumatic stress disorder (PTSD) treatment, treatment for anxiety A routine urinalysis consists of physical, disorders, behavioral disorders and chemical, and microscopic examination of urine. more. The physical examination evaluates the color, clarity, and specific gravity of the urine. The 10. Nursing homes. nursing homes chemical examination is performed using offer a living situation for patients whose chemical reagent strips (dipsticks) to determine medical needs aren‘t severe enough for pH, glucose, ketones, protein, blood, bilirubin, hospitalization, but are too serious to urobilinogen, nitrite, and leukocytes. The manageat home. microscopic examination identifies the presence of cells, casts, bacteria, crystals, yeast, and 11. Orthopedic and other Rehabilitation parasites (automated system can perform UA). centers Urine samples should be examined within 2 orthopedic centers deal in everything from hours after collection. For routine examination a athletic injuries to therapy for patients with first morning sample is preferred because it is disabilities. They typically offer evaluation and more concentrated. diagnosis of the problem, as well as prevention, treatment and rehabilitation work involving bone, tendon, ligament, muscle and joint conditions. 12. Reference Laboratory – it is a large and independent lab. that provides specialized and confirmatory lab. Tests on blood, urine, and tissues and offers faster turnaround or processing time. Clinical Laboratory has two majordivisions: 1. Anatomical and Surgical Pathology – handles tests related to Histology (microscopic structure of tissues) Hematology Histopathology & Cytology  The hematology section performs Histopathology section is where surgical routine and special tests on the specimens are examined at the microscopic components of whole blood such as level for pathologic diagnosis and the red blood cells, white blood cells, interpretation. Cytology section examines and platelet. smears of body fluids for evidence of  The section also performs cell inflammation, cancer, and other conditions. counts, differential counts, and other Serology microscopic examination of serology section is where patients‘ blood cerebrospinal fluid (CSF) and other samples are examined for the of antibodies body fluids. produced against infectious agents that  The most common body fluid causes hepatitis, measles, and HIV. analyzed in hematology section is Donor Serology whole blood (a mixture of cells and plasma). This specimen is obtained Donor serology section specifically by using a collection tube with examines donors‘ blood samples for anticoagulant to prevent clotting presence of antibodies. This is to ensure of the blood. lavender stopper that contains the blood that will be used for patient EDTA (ethylenediaminetetraacetic acid). administration is free of infectious diseases. Blood Bank Blood bank prepares blood components, derivatives, and products for transfusion.  The liquid portion of blood is called Blood bank ensures that the donor is plasma if it is obtained from a sample that free of infectious diseases. They are also has been anticoagulated. If the sample is in charge of ensuring that there is a allowed to clot, the liquid portion is called supply of various blood products that are serum. The major difference between readily available for patient plasma and serum is that plasma administration. contains the protein fibrinogen and serum does not. Blood bank is also called Microbiology Immunohematology section because the testing procedures involve RBC antigens Microbiology section is where patients‘ (Ag) and antibodies (Ab). In blood bank, samples are examined microscopically for blood from patient and donor is tested agents of infectious diseases. Specimens for its blood group (ABO) and Rh type, that can be examined may come from the presence and identity of abnormal wounds, throats, eye, blood, body fluids, and antibodies, and its compatibility many other body sites. The agents that are (crossmatch) for use in a transfusion. detected may be bacteria (aerobic, anaerobic, acid fast), fungi (molds and Sample Collection and Handling: yeasts), parasites,or viruses. Blood bank samples are Culture and Sensitivity (C & S) test is collected in plain red (serum), lavender, the primary procedure performed in or pink (plasma) stopper tubes. microbiology. It is used to detect and identify microorganisms and to determine the mosteffective antibiotic therapy. Drug Testing Tests Performed in the Serology (Immunology) Section: the drug testing laboratory performs screeningtests for prohibited drugs. Immunology is the section where blood samples are analyzed to quantify tumor markers and thyroid hormones. Out Patient Receiving & Releasing Area this is where out-patients go to have blood samples taken or submit specimen to be analyzed by the laboratory. This is also where the out-patients can claim the results of their laboratory requests. Newborn Screening this section provides an assessment if baby has conditions that can affect its long-term health or survival. An example of which is a metabolic disorder that may lead to mental retardation or even death if left untreated. Clinical Chemistry this section is where patients‘ blood and other body fluids are checked for various chemical components. Instruments are computerized and designed to perform single and multiple tests from small amounts of specimen. Sample Collection and Handling (for Clinical Chemistry) Clinical chemistry tests are performed primarily on serum collected in gel barrier tubes, but the serum may also be collected in tubes with red, green, gray, or royal blue stoppers. Tests are also performed on plasma, urine, and other body fluids. Tests Performed in the Blood Bank Section: Tests Performed in the Chemistry Section:  MODULE 2 SAFETY AND INFECTION CONTROL, SAFETY, FIRST AID, AND PERSONAL WELLNESS An infection happens when a Infection Control Program microorganism invades the body, multiplies, and A healthcare institution should have a set of causes injury or disease. A pathogen is a disease- procedures to break the chain of infection. These causing microbe which could be classified as measures include: bacteria,fungi, protozoa, or virus. a. Hand hygiene procedure Components of the Chain of Infection: b. Good nutrition The chain of infection requires a continuous link c. Immunization against common pathogens between six components. To prevent infection, it d. Insect and pest control is necessary to understand the components that e. Isolation and decontamination procedures make up the chain and the methods by which the f. Use of Proper safety devices (wearing of chain can be broken. The components in the personal protective equipment) when chain are: needed. CHAIN OF INFECTION g. Proper disposal of sharp objects and otherwaste materials. 1. Infectious Agent- Breaking the Chain – An infection-control program has four main Early detection and treatment of infectious functions: agents. 2. Reservoir – a place where the infectious 1. To protect patients, employees, and agent can live and possibly multiply. visitors from infection 3. Portal of Exit – a way to exit the reservoir to 2. To screen employees for infectious continue the chain of infection. diseases and to require immunization 4. Means of Transmission – a way to reach a when needed susceptible host. 3. To provide evaluation and treatment 5. Portal of Entry – a means to enter the to health workers who have been reservoir. exposed to infections while 6. Susceptible Host – can be another person performingtheir duty who is liable to be harmed by a particular 4. To monitor employees and patients thing. who are at risk of infection and to collect data from patients and health workers who have been exposed to such danger. TRANSMISSION PREVENTION PROCEDURES Procedures used to prevent microorganism transmission are: 1. Hand hygiene See page () 2. Wearing of Personal Protective Equipment 3. Isolation of highly infective or highly susceptible patients, and proper disposal of contaminated materials.  Procedure: Infection Control Procedures 1. Wet hands with warm water. Do not allow parts of body to touch the sink. Infection control procedures should be 2. Apply soap, preferably antimicrobial. applied so as to prevent the transmission of 3. Rub to form a lather, create friction, and microorganisms from the infected reservoir to loosen debris. Thoroughly clean between susceptible hosts and to control the spread of the fingers and under the fingernails for infection. at least 20 seconds; include thumbs and A. HAND HYGIENE INCLUDES BOTH wrists in the cleaning. HAND WASHING AND THE USE OF 4. Rinse hands in a downward position to ALCOHOL- BASED ANTISEPTIC prevent recontamination of hands and CLEANERS wrists. Hand Hygiene – includes both hands washing and 5. Obtain paper towel from dispenser. the use of alcohol-based antiseptic cleansers. 6. Dry hands with paper towel. Hands should always be washed: 7. Turn off faucets with a clean paper towel toprevent recontamination.  Before patient contact  When gloves are removed  Before leaving the work area B. PERSONAL PROTECTIVE  At any time when they have been EQUIPMENT(PPE) knowingly contaminated PPE encountered by the phlebotomist  Before going to designated break areas includes gloves, gowns, masks, goggles,  Before and after using the bathroom faceshields, and respirators. facilities Gloves Phlebotomists should always wear gloves during blood collection and when handling specimen. Gloves are worn to prevent contamination of the hands and reduce chances of transmission of microorganisms from personnel to patients. They should be worn over the cuffs of the laboratory gown to ensure protection. Gowns are worn to protect the clothing and skin of See page () health-care workers from contamination by patient body substances and to prevent the transfer of microorganisms out of patient Proper Procedure of Hand Washing: rooms. Materials: Masks, Goggles, and Face shields Masks are worn to protect against inhalation of  Antimicrobial soap droplets containing microorganisms from  Paper towels infective patients. Masks, goggles and face  Running water shields are worn to protect the mucous  Waste container membranes of the mouth, nose, and eyes from  splashing of body substances. 5. Gloves are donned last and securely pulled over the cuffs of the gown. Proper Removal off Gloves 1. The wrist part of one glove is grasped by the opposite hand. 2. The glove is pulled inside out and off the hand. 3. The recently removed glove must be placed in the gloved hand. The fingers of the non- gloved hand are slipped under the wrist of the remaining glove but make sure not to touch the exterior surface. 4. The second glove is pulled inside out. Doffing of PPE 5. The gloves must be dropped in the proper receptacle. 1. Gloves are the most contaminated. They are removed first. DONNING AND DOFFING OF PPE 2. The first glove is pulled off using the gloved hands so that it will end up inside The PPE is kept clean and is worn to protect out in thestill gloved hand. the healthcare worker from splashes of blood and specimen during the patient-care activities. It 3. Remove the second glove by sliding the ungloved finger inside the glove of the includes the laboratory gown or coat, face mask, other hand and remove the glove without and gloves. touching the outside of the glove. 4. Dispose of gloves in a biohazard container. 5. Untie/ unbutton the gown and remove it bytouching only the inside of the gown 6. Dispose of the gown in a biohazard container 7. Remove the mask touching only the strings 8. Unfasten the lower tie first so that the mask will not fall forward while removing the lower tie. Dispose of the mask in a biohazard container. STANDARD PRECAUTIONS Donning of PPE Standard Precautions are the minimum 1. The gown is put on first and tied infection prevention practices that apply to all 2. Place face protection over the nose and patient care, regardless of suspected or mouth confirmed infection status of the patient, in 3. Masks with ties are fastened first at the top, any setting where health care is adjusted to the nose and mouth, tied at the delivered. Standard Precautions include: neck and refitted. Masks with straps are fitted 1. Hand hygiene. to the nose and mouth. 2. Use of personal protective equipment 4. When needed, goggles and face shields are (e.g., gloves, masks, eyewear). put on after the mask and adjusted forfit. 3. Respiratory hygiene / cough etiquette.  4. Sharps safety (engineering and work 5. Permucosal – infection through mucous practice controls). membranes of the mouth and nose and the 5. Safe injection practices (i.e., conjunctiva of the eyes. aseptic technique for parenteral a. Observe proper handling to avoid medications). aerosols and splashes. 6. Sterile instruments and devices. b. Avoid rubbing and touching the 7. Clean and disinfected environmental eyes, nose, and mouth. surfaces. Hazard, Actions to Take if Incidents Occur, and Other Terminologies in Disease Transmission: Laboratory Safety Risks 1. Direct Contact Transmission– occurs Biohazard refers to any material that could be when there is physical contact between an harmful to one‘s health. Biosafety is used to infected person and a susceptible person. prevent and protect clinical laboratories from harmful incidents caused by laboratory 2. Indirect Contact Transmission- occurs specimens that are potential biohazards when there is no direct human-to-human contact. Contact occurs from a reservoir to A health worker could be exposed to a contaminated surfaces or objects, or to biohazard in various ways. These ways are vectors such as mosquitoes, flies, mites, called the biohazard exposure routes. fleas, ticks, rodents or dogs. 1. Airborne – from splashes and aerosols Fire is another potential work hazard. during centrifuge and aliquot; patients with Regular fire drills should be conducted so airborne diseases. employees & students would know what to a. Observe proper handling practices. do in case of fire. They should also be b. Wear PPE properly. familiar with the location of emergency exits c. Use safety shield and guards and evacuation plans or routes. The location of fire extinguishers and heavy blankets 2. Ingestion – hands are not sanitized before should be posted, and the staff should know handling food. how to use them. a. Wash hands frequently. Fire extinguishers are classified by b. Avoid hand-to-mouth activities. the type of fire that they are designed to c. Avoid placing items in the mouth. extinguish. 3. Non-intact skin – contamination through breaks or cuts in the skin. a. Cover skin breaks or cuts with non- permeable bandages 4. Percutaneous – exposure through the skin due to injuries from needlesticks and other sharp objects. a. Use needle safety devices. b. Wear heavy-duty utility gloves when cleaning broken glass. c. Never handle broken glass with bare hands. Airborne Precautions (in addition to standard precautions) are necessary when microorganisms Droplet Infection – are required for can remain infective while being carried through persons infected with microorganisms that can be the air on the dried residue of a droplet or on a transmitted on moist particles such as those dust particle. PPEmay include a respirator. produced during coughing and sneezing. Droplets are capable of traveling only short distances through the air, less than 3 feet; therefore, masks are worn when procedure requiring close patient contact are performed. Contact Precautions – are used when patients have an infection that can be transmitted by direct skin-to-skin contact or byindirect contact by touching objects in the patient‘s room. Biological Waste Disposal Phlebotomy equipment and supplies contaminated with blood and body fluids must be disposed of in containers clearly marked with biohazard symbol or red or yellow color coding. These items include alcohol pads, gauze, bandages, disposable tourniquets gloves, masks, gowns and specimens except urine. Sharp Hazards Although bloodborne pathogens also are transmitted through contact with mucous membranes and non-intact skin, a needle or lancet used to collect blood has the capability to produce a very significant exposure to bloodborne pathogens. Bloodborne Pathogens HOW TO USE THE FIRE EXTINGUISHER Bloodborne pathogens are of particular concern Fire extinguishers should not be used by to health-care workers because of their exposure people who have not been trained. Before to blood and sharp objects such as needles. Of tackling a fire with a fire extinguisher make primary concern are Human Immunodeficiency sure you or someone else has raised the fire Virus (HIV), Hepatitis B virus (HBV), Hepatitis C alarm and that you have a safe evacuation virus (HCV). route. Using the correct type of Use of Capillary Tubes extinguisher for the fire, use the four-step Accidental breakage of glass capillary tubes PASS technique. used by phlebotomists when collecting samples 1. Pull the pin, this will break the tamper seal. from a dermal puncture can present a major risk of bloodborne pathogen exposure. A 1999 2. Aim low, pointing the nozzle or hose at government safety advisory recommended using the base of the fire. Do not touch the horn the following items: on a CO2 extinguisher, it gets very cold and candamage the skin. 1. Capillary tubes wrapped in puncture- 3. Squeeze the handle to release the resistant film extinguishing agent. 2. Plastic capillary tubes 4. Sweep from side to side at the base of 3. Sealing methods that do not require thefire, the fuel source, until the fire is out. pushing the tubes into a sealant to form a plug 4. Methods that do not require centrifugation of capillary hematocrit tubes Post-exposure Prophylaxis Needlesticks are the most frequently encountered exposure in phlebotomy and place the phlebotomist in danger of contracting HIV, HBV, and HCV. Evaluation of the incident must begin immediately to ensure appropriate post- exposure prophylaxis (PEP) is initiatedwithin 24 hours. Fire/Explosive Hazard Phlebotomists should be familiar with the basic steps to follow when a fire is discovered. The code word is RACE. 1. Rescue – anyone in immediate danger. 2. Alarm – activate the institutional fire alarmsystem 3. Contain – close all doors to potentially affected areas 4. Extinguish / Evacuate – extinguish the fire, if possible, or evacuate, closing the door.  monitoring their breathing and perform CPR if they stop breathing. CPR steps Use the following steps to perform CPR: Step 4. Perform 30 chest compressions  Place one of your hands on top of the other and clasp them together. With the heel of the hands and straight elbows, push hard and fast in the center of the chest, slightly below the nipples. Push at least 2 inches deep. Compress their chest See page () at a rate of least 100 times per minute. Let the chest rise fully between compressions. CPR step-by-step There are two main stages to CPR: the preparation stage and the CPR stage. Preparation steps Before performing CPR on an adult, use the following preparation steps: Step 1. Check the person. Do you need help?  Tap his shoulder and shout, "Are you OK?"  If they are not responding, call 911 or ask a bystander to call 911 before performing CPR. Step 5. Perform two rescue breaths Step 2. Place the person on their back and open their airways  Making sure their mouth is clear, tilt  Place the person carefully on their back their head back slightly and lift their and kneel beside their chest. Tilt their head chin. Pinch their nose shut, place your back slightly by lifting their chin. mouth fully over theirs, and blow to  Open their mouth and check for any make their chest rise. obstruction, such as food or vomit. Remove  If their chest does not rise with the any obstruction if it is loose. first breath, re-tilt their head. If their chest still does not rise with a second Step 3. Check for breathing breath, the person might be choking.  Place your ear next the person's mouth and listen for no more than 10 seconds. If you do not hear breathing, or you only hear occasional gasps, begin CPR.  If someone is unconscious but still breathing, do not perform CPR. Instead, if they do not seem to have a spinal injury, place them in the recovery position. Keep Step 6. Repeat person. With one of you at the head and another along the side of the injured person, work  Repeat the cycle of 30 chest together to keep the person's head, neck and compressions and two rescue breaths until back aligned while rolling the person onto one the person startsbreathing or help arrives. side. Spinal injury: First aid Stress Management Tips If you suspect a back or neck (spinal) injury, donot  Keep a positive attitude. move the affected person. Assume a person has  Accept that there are events that you a spinal injury if: cannot control.  There's evidence of a head injury with an  Be assertive instead of aggressive. ongoing change in the person's level of Assert your feelings, opinions, or beliefs consciousness instead of becoming angry, defensive, or  The person complains of severe pain in passive. his or her neck or back  Learn and practice relaxation techniques;  An injury has exerted substantial force on try meditation, yoga, or tai-chi for stress the back or head management.  The person complains of weakness,  Exercise regularly. Your body can fight numbness, or paralysis or lacks control of stress better when it is fit. his or her limbs, bladder or bowels  Eat healthy, well-balanced meals.  The neck or body is twisted or positioned  Learn to manage your time more oddly effectively. If you suspect someone has a spinal injury:  Set limits appropriately and learn to say no to requests that would create  Get help. Call 911 or emergency medical excessive stress in your life. help.  Make time for hobbies, interests, and  Keep the person still. Place heavy towels or relaxation. rolled sheets on both sides of the neck or  Get enough rest and sleep. Your body hold the head and neck to prevent needs time to recover from stressful movement. events.  Avoid moving the head or neck. Provide as  Don't rely on alcohol, drugs, or much first aid as possible without moving the compulsivebehaviors to reduce stress. person's head or neck. If the person shows  Seek out social support. Spend enough no signs of circulation (breathing, coughing time with those you enjoy. or movement), begin CPR, but do not tilt the  Seek treatment with a psychologist or head back to open the airway. Use your other mental health professional trained fingers to gently grasp the jaw and lift it in stress management or biofeedback forward. If the person has no pulse, begin techniques to learn healthy ways of chest compressions. dealingwith the stress in your life. Keep helmet on. If the person is wearing a Personal Wellness helmet, don't remove it. A football helmet facemask should be removed if you need to Personal wellness begins with access the airway. personal hygiene, which includes bathing regularly, etc. One should have proper Don't roll alone. If you must roll the person nutrition and have a balanced diet consisting because he or she is vomiting, choking on blood of vegetables, fruits, and legumes. Getting enough sleep and staying fit by having or because you have to make sure the person regular exercise routine. is still breathing, you need at least one other  2. Right Ventricle – lower right chamber, MODULE 3: THE CIRCULATORY SYSTEM that receives the blood from the right atrium and pumps it into the pulmonary Circulatory System is responsible for artery. transporting throughout the body. 3. Left Atrium – upper left chamber, that  oxygenated blood from the heart and lungs receives oxygenated blood from the via the arteries. Then the oxygen-depleted lungs and pumps it into the left blood is returned to its origin through the ventricle. veins. 4. Left Ventricle – lower left chamber,  The circulatory system delivers the oxygen that receives blood from the left atrium and nutrients to all cells in the human body. It and pumps it into the aorta. transports carbon dioxide and other wastes Heart Function to the other organs of the body and away from the cells. It helps in the coagulation The coronary circulation supplies the process, regulates body temperature, and blood as well as provides drainage to the assists the body in fighting diseases. tissues. It is composed of the left and right  This system is made up of two main coronary arteries and coronary veins. Poor components: the cardiovascular system that circulation could lead to ischemia which is is composed of the heart, blood vessels, caused by inadequate supply of oxygen and and blood which helps in the circulation; and myocardial infarction or heart attack which the lymphatic system, which is made up of may be due to compete obstruction of the the lymph, lymphnodes, and vessels. coronary artery. Layers and Other Structures of the Heart Disorders and Diagnostic Tests The human heart may have The heart is a hollow muscular organ disorders that can be detected and that has four chambers (left atrium, right atrium, addressed using theproper diagnostic tests. left ventricle, and right ventricle) and is surrounded by a thin, fluid-filled sac called 1. Angina pectoris – chest pain pericardium. resulting from reduced blood flow to the heart. Layers of the Heart 2. Aortic stenosis – a murmuring 1. Epicardium – thin, watery membrane on sound produced when the aortic the outer layer of the heart. It covers the heart leaflets fail tofully open during systole. and is attached to the pericardium, 3. Bacterial endocarditis – an infection that happens when a bacteria enters 2. Myocardium – thick layer of cardiac and resides in the heart lining or muscles in the middle layer of the heart. It blood vessel. pumps blood into the arteries by contracting. 4. Congestive heart failure – a chronic progressive condition that affects the 3. Endocardium – thin layer of epithelial cells in pumping power of the heart muscles, the inner layer of the heart. It lines the valves and 5. Myocardial infarction – known as interior chambers. heart attack, it is caused by a Chambers of the Heart decreaseor full stoppage of blood flow that damages the heart muscle. 1. Right Atrium – upper right chamber, 6. Pericarditis – inflammation of the that receives deoxygenated blood from pericardial sac that may be due to thebody. viral infection.  List of Diagnostic Tests for Heart Disorders: Arterioles – small-diameter blood vessels that branch out from the arteries and lead to  Arterial blood gases (ABG) the capillaries.  Aspartate aminotransferase (AST) or Serum glutamic-oxaloacetic transaminase Veins – tubes with thin walls that carry (SGOT) deoxygenated blood from tissues to the  Cholesterol heart.  Creatine kinase (CK)  Creatine kinase (CK)- MB  have thinner walls than arteries and  Digoxin carry oxygen-poor blood, carbon  Electrocardiogram (ECG or EKG) dioxide, and other waste products  Lactate dehydrogenase (LDH) back to the heart. No gaseous isoenzymes exchange takes place in the veins,  Microbial cultures only in the capillaries. The thinner  Myoglobin walls of veins have less elastic tissue  Potassium and less connective tissue than  Triglycerides arteries because the BP in the veins  Troponin T (TnT) is very low. Veins have one-way valves to keep blood flowing in one direction as the blood flows through Vascular System and The Pathway of the the veins by skeletal muscle Blood Through the Heart contraction.  Most blood tests are performed on venous blood. Venipuncture is the The vascular system is the loop procedure for removing blood from a consisting of a network of blood vessels vein for analysis. The veins of choice through which blood is circulated to the rest of for venipuncture are the basilic, the body. There are two divisions: the cephalic, and median cubital veins pulmonary circulation and the systemic located in the antecubital area of the circulation. The pulmonary circulation moves elbow. the blood between the right ventricle of the Venules – are small veins that connect heart to the lungs. During the process, oxygen capillaries to larger veins. is absorbed and carbon dioxide is released, after which, the oxygenated blood flows back Capillaries – fine hair-like blood vesselsthat to the left atrium of the heart. The systemic connect arterioles and veins. circulation moves the oxygenated blood and nutrients from the left ventricle of the heart to  are the smallest blood vessels. the rest of the body. The deoxygenated blood They consist of a single layer ofepithelial with carbon dioxide and wastes flows back to cells to allow exchanges of oxygen, carbon the right atrium. dioxide, nutrients, and waste products between the blood andtissue cells. The STRUCTURE OF THE VASCULAR blood in capillaries is amixture of arterial and SYSTEM venous blood. Arteries – thick-walled blood vessels that carry BLOOD VESSEL STRUCTURE: oxygen-rich blood from the heart to the tissues of a. Layers – the blood vessels have three the body. layers:  Arteries branch into smaller thinner vessels  tunica adventitia/ externa- the called arterioles that connect to the outer layer composed of connective capillaries. tissue.  to the left atrium of the heart. The blood flows through the mitral valve into the left  tunica media- the middle layer composed ventricle thatcontracts to pump blood of smooth muscle and elastic tissue. through the aortic semilunar valve into the  tunica intima- the inner layer composed aorta. Blood travels throughout the body to of lining of epithelial cells. the capillaries from arteries that branch off b. Lumen – space inside the blood vessel theaorta. where the blood flows. Heart Rate/Pulse Rate c. Valves – found inside the veins, these are thin The heart contracts approximately 60 to membranous leaflets that prevent the backflow of 80 times per minute, which represents the blood. heart rate or pulse rate. The arterial pulse is a rhythmic recurring wave that occurs through the arteries during normal pumping action of the heart. The pulse is most easily detected by palpation where an artery crosses over a bone or firm tissue. Common pulse sites are the temporal, carotid, brachial, and radial arteries. DISORDERS OF THE VASCULAR SYSTEM/ BLOOD VESSELS 1. Aneurysm – enlargement of the artery due to the weakening of the artery wall. 2. Arteriosclerosis – hardening of the artery walls due to aging. 3. Atherosclerosis – formation of plaquesin the inner walls. PATHWAY OF THE BLOOD THROUGH 4. Embolism – clot or bubble that THE HEART causesobstruction of an artery. The two large veins, superior vena 5. Embolus – obstruction that is cava and the inferior vena cava, transport carriedand lodged in a vessel. oxygen- poor blood to the right atrium of the 6. Hemorrhoids – swollen veins in the heart. The superior vena cava collects area of the anus. blood from the upper portion of the body, 7. Phlebitis – inflammation of the and the inferior vena cava collects blood veinsparticularly the wall from the lower portion of the body. The 8. Thrombophlebitis – swelling of blood passes through the tricuspid valve to the veins of the legs that usually the right ventricle. The right ventricle occursduring pregnancy. contracts to pump the blood through the 9. Thrombus – blood clot that impedes pulmonary semilunar valve into the right blood flow. and left pulmonary arteries that carry it to 10. Varicose veins – usually found in each lung. In the lung capillaries, blood the legs, these are veins that have releases carbon dioxide and acquires been twisted and enlarged. oxygen. The right and left pulmonary veins carry the oxygenated blood from the lungs Diagnostic Tests: D-dimer, Fibrin (red blood cells (RBCs)), leukocytes degradation products (FDP), Lipoproteins, (white blood cells (WBC)), and Prothrombin time (PT), Partial thromboplastin thrombocytes (platelets). time (PTT/APTT), Triglycerides  Blood cells are produced in the bone marrow, which is the spongy Blood Pressure material that fills the inside of the BP is the pressure exerted by the blood on the major bones of the body. Cells walls of blood vessels during contraction and originate from stem cells in the bone relaxation of the ventricles. Systolic and diastolic marrow, differentiate, and mature readings are taken and reported in millimeters of through several stages in the bone mercury (mmHg). The systolic pressure is the marrow and lymphatic tissue until higher of the two numbers and indicates the BP they are released to the circulating during contraction of the ventricles. The diastolic blood. pressure is the lower number and is the BP when the ventricles are relaxed. Three Types of Cells in the Human Blood: Blood 1. Erythrocytes (red blood cells) - carry Blood is the body‘s main fluid for transporting O2 and CO2 and are produced in the bone nutrients, waste products, gases, and hormones marrow. through the circulatory system. An average adult has a blood volume of 5 – 6liters. Blood consists of  Are a nuclear biconcave disk that two parts: the liquid portion called the plasma, and are approximately 7.2µ (microns) in a cellular portion called the formed elements. diameter. Erythrocytes contain the protein hemoglobin to transport oxygen and carbon dioxide. Hemoglobin consists of two parts, heme and globin. The heme portion requires iron for its synthesis. There are approximately 4.5 – 6.0 million erythrocytes per microliter (µL) of blood, with men having slightly higher values than women. The normal life span of erythrocyte is 120 days. 2. Leukocytes (white blood cells) – formed in the marrow and the lymphatic tissue. They neutralize pathogens. The two  Plasma comprises approximately types are granulocytes and agranulocytes. 55% of the total blood volume. It is a clear, straw- colored fluid that is  provide immunity to certain diseases about 91% water and 9% dissolved by producing antibodies and substances. It is the transporting destroying harmful pathogens by medium for the plasma proteins, phagocytosis. Leukocytes are nutrients, minerals, gases, vitamins, produced in the bone marrow from a hormones, and blood cells, as well stem cell and develop in the thymus as waste products of metabolism. and bone marrow. They differentiate The formed elements constitute and mature through several stages approximately 45% of the total blood before being released into the volume and include the erythrocytes bloodstream.   Leukocytes circulate in the group O blood has neither the ―A‖ nor the ―B‖ peripheral blood for several hours antigens. Group O and A are the most common, and then migrate to the tissues and group AB is the least common. through the capillary walls. The normal number of leukocytes for an The plasma of an individual contains adult is 4,500 to 11,000 per (µL) of naturally occurring antibodies for those blood. antigens not present on the erythrocytes. 3. Thrombocytes (platelets) – pieces of very Group A blood has anti-B antibodies in the large cells in the bone marrow that help form plasma, and group B blood has anti-A blood clots. antibodies. Group O blood has both the anti- A and anti-B antibodies, and group AB blood  irregularly shaped disks formed from the has neither anti-A nor anti-B antibodies. cytoplasm of very large cells in the bone marrow called the megakaryocytes. Platelets have a life span of 9-12 days. The average number of platelets is between 140,000 and 440,000 per µL of blood. Platelets play a vital role in blood clotting in all stages of the coagulation mechanism. Blood Type The human blood type is inherited and determined by the antigens on the surface of the red blood cells. The blood contains or can develop antibodies directed at the opposite Cross-matching is necessary to blood type. Blood type match is important determine the compatibility of the donor‘s especially during transfusion because the wrong blood with the recipient‘s blood because an type could agglutinate the red blood cells. When individual who does not produce the D a doctor mentions blood type, he/she is referring antigen will produce anti-D which could be to a person‘s ABO blood group system or fatal if it encounters the D antigen. Rhesus (Rh) factor. Four Stages of Coagulation/Hemostasis: ABO BLOOD GROUP SYSTEM This is a system of classifying human blood by the presence of antigens A and B and based on the antigenic components found on the surface of the red blood cells. A person‘s blood could be classified as A, B, O (universal donor), or AB (universal recipient). In Rh factor or the ―D‖ antigen testing, Rh positive (Rh+) has red blood cells that have the D antigen, while the Rh negative (Rh-) does not have the D antigen. Stage 1, also called primary hemostasis, blood vessels and platelets respond to an Group A blood has the ―A‖ antigen, and injury to a blood vessel. Blood vessels group B blood has the ―B‖ antigen. Group AB constrict to slow the flow of blood to the blood has both the ―A‖ and ―B‖ antigens, and  injured area. Platelets become sticky, clump together(platelet aggregation), and adhere to the injured blood vessel wall (platelet adhesion) to form a temporary platelet plug to stop the bleeding. Stage 2 Formation of the primary platelet plug – platelets stick together on the site of the injury forming a plug. Whole blood, serum, and plasma There are three blood specimens that are collected for testing purposes: serum, plasma, and whole blood. Serum is the fluid part of the blood that is left after clotting because it does not have fibrinogen. This can be separated by centrifugation. Plasma refers to the fluid portion that is separated by centrifugation from the red blood cells, white blood cells, and platelets. It has fibrinogen and could be collected using an anticoagulant tube. It is also collected in cases Stage 3 where serum could not be used. The whole blood The last factor in the coagulation cascade(Factor is the same as blood in the bloodstream and it XIII) stabilizes the fibrin clot. This produces should neither clot nor separate. Just like retraction (tightening) of the clot or progression plasma, it could be collected using the to the stable blood clot. anticoagulant tube and must be mixed for a minimum of 2 minutes prior to testing. BLOOD DISORDERS 1. Anemia – caused by not having enough healthy red blood cells or hemoglobin. 2. Leukemia – cancer of the blood; the formation of abnormal tissues or cells in the bone marrow or the lymphatic system. Stage 4 3. Urinary tract infection – shown higher number of leukocytes. After the injury to the blood vessel has healedthe 4. Leukocytosis – increased number of process of fibrinolysis degrades (breaks down) white blood cells in the blood due to the fibrin clot into fibrin degradation products illness or infection. (fibrinolysis or dissolving of clot). 5. Leukopenia – reduced number of white cells in the blood. 6. Polycythemia – the marrow produces too many red blood cells resulting in the thickening of blood. 7. Thrombocytosis – the body  produces too many platelets Fibrinolysis (thrombocytes) which affect the blood Fibrinolysis is the process in which clotting. the fibrin is dissolved. It has two main 8. Thrombocytopenia – characterized activities: by low platelet count. Diagnostic Tests: 1. Reopens intact vessels by dissolving clots  ABO and RH type  Bone marrow examination 2. Removes hemostatic clots from the tissue as part of the healing process.  Complete blood count (CBC)  Cross-matching Hemostatic Disorders:  Differential (diff) count  Eosinophil count 1. Deep venous thrombosis (DVT)  Erythrocyte sedimentation rate (ESR) 2. Disseminated  Ferritin intravascularcoagulation  Hematocrit (Hct) 3. Hemophilia  Hemoglobin (Hb or Hgb) 4. Thrombocytopenia  Hemogram Diagnostic Tests:  Indices (MCH, MCV, MCHC)  Iron (Fe)  Bleeding time  Reticulocyte (retic count)  D-dimer  Total iron-binding capacity (TIBC)  Factor assays Coagulation Factors and Pathways  Fibrin degradation products (FDP)  Platelet function assay (PFA) Coagulation or clotting is the process in  Prothrombin time (PT) which the blood changes from a liquid state into a  Partial thromboplastin time (PTT or APTT) gel that forms the blood clot. The clotting cascade has two separates but interacting pathways: the extrinsic pathway which is activated by external trauma (initiates coagulation) and the intrinsic pathway which is activated by trauma inside the bloodstream (produces thrombin). It has three cell-based coagulation phases, namely initiation, amplification, and propagation. Role of the Thrombin Thrombin is an enzyme that plays an important role in coagulation. It is produced at the site of injury from the prothrombin. It amplifies coagulation and converts fibrinogen into soluble fibrin. This supports the platelet plug formation by activating factor XIII to cross-link fibrin and also to control the formation and coagulation process by activating protein C. MODULE 4: BLOOD COLLECTION EQUIPMENT, (23-gauge) needles used for very small veins. ADDITIVES, AND ORDER OF DRAW All needles consist of a bevel (angled point), shaft, lumen, and hub. ORGANIZATION OF EQUIPMENT: Routine Venipuncture Equipment:  Phlebotomy collection tray  Evacuated tube system holders  Syringes  Winged blood collection sets  Needles  Needle disposal sharps containers  Evacuated collection tubes  Transfer devices  Tourniquets  Gloves Needle Holders  70 percent isopropyl alcohol, iodine swabs, chlorhexidine gluconate swabs Needles used in venipuncture is attached to a holder that holds the collection tube. Holders  2X2 inch gauze pads are made of rigid plastic and may be designed to  Bandages act as a safety shield for the used needle.  Slides  Antimicrobial hand gel  Marking pen Phlebotomy Collection Tray – provides a convenient way for the phlebotomist to carry equipment to the patient‘s room. Evacuated Tubes is the most frequently used method for performing venipuncture. Blood is collected directly into the evacuated tube, Needle disposal system eliminating the need for transfer specimens and minimizing the risk of biohazard exposure. The A means of safe disposal must be available evacuated tube consists of a double- pointed whenever phlebotomy is performed. Needles with needle to puncture the stopper of the collection safety devices activated must always be placed in tube, a holder to hold the needle and blood rigid, puncture-resistant, leak-proof disposable collection tube, and color-coded evacuated ―sharps‖ containers labeled BIOHAZARD that are tubes. easily sealed and lockedwhen full. Needles – venipuncture needles include multisample needles, hypodermic needles, and winged blood collection needles. Needles used in venipuncture are sterile, disposable, and are used only once. Needle gauge refers to the diameter of the needle bore. Needles vary from large (16-gauge) needles used to collect units of blood for transfusion to much smaller Collection tubes PRINCIPLES AND USE OF COLOR-CODED TUBES Tubes used for blood collection are called evacuated tubes because they contain a Color coding indicates the type of premeasured amount of vacuum. The collection sample that will be obtained when a particular tubes used with the evacuated tube system are tube is used. Tests may be run on plasma, often referred to as Vacutainers. The amount of serum, or whole blood. Tests may also require blood collected in an evacuated tube ranges the presence of preservatives, inhibitors, clot from 1.8 to 15 ml and is determined by the size activators, or barrier gels. of the tube and the amount of vacuum present. The tubes are sterile and many are silicone Tests requiring whole blood or plasma coated to prevent cells from adhering to the are collected in tubes containing an tube, or to prevent the activation of clotting anticoagulant to prevent clotting of the sample. factors in coagulationstudies. Anticoagulants prevent clotting by binding calcium or inhibiting thrombin in the coagulation cascade. Ethylenediaminetetraacetic acid (EDTA), citrates, and oxalates are the most common anticoagulants that work by binding calcium. Heparin prevents clotting by inhibiting the formation of thrombin necessary to convert fibrinogen to fibrin in the coagulation process. All tubes containing an anticoagulant must be gently inverted 3-8 times immediately after collection to mix the contents and to avoid microclot formation. Tubes with powdered anticoagulant should be gently tapped to loosen the powder from the tube for better mixing with the blood. Tubes containing an anticoagulant must be filled to the designated volume draw to ensure the correct blood-to- anticoagulant ratio and accurate test results. Lavender (Purple) Top Lavender stopper tubes and Hemogard closures contain the anticoagulant ethylenediaminetetraacetic acid (EDTA) in the form of liquid tripotassium or spray-coated dipotassium enthylenediaminetetra-acetic acid (K3EDTA or K2EDTA). Coagulation is prevented by the binding of calcium in the sample to sites on the large EDTA molecule, thereby preventing the participation of the calcium in the coagulation cascade. Lavender stopper tubes should be gently inverted